Potassium2026-06

Pathophysiological Mechanisms and Clinical Controversies of Sodium-Induced Hypertension: A Multi-Systemic Perspective.

Yun Hyeong Rok, Singh Manish Kumar, Han Sunhee, Ranbhise Jyotsna S et al. — Nutrients

Summary

This paper explores the complex ways sodium contributes to high blood pressure, moving beyond traditional views. It highlights new research on how sodium affects blood vessel health, tissue sodium storage, and gut-immune interactions. The review also questions past studies on salt intake, suggesting that a personalized nutrition approach, considering individual salt sensitivity and the balance of sodium and potassium, is more effective than universal sodium restriction.

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Abstract

Hypertension remains the primary modifiable driver of global cardiovascular morbidity, yet the long-standing paradigm of universal sodium restriction is increasingly challenged by the intricate biological heterogeneity of salt sensitivity. This review elucidates the evolving pathophysiological landscape of sodium-induced hypertension, transcending the classical Guytonian pressure-natriuresis model to incorporate emerging evidence of endothelial glycocalyx degradation, non-osmotic interstitial sodium sequestration, and gut-immune axis dysregulation. Furthermore, we critically interrogate the epidemiological "salt controversy," examining how methodological artifacts-specifically the systematic biases inherent in spot urine sampling-may contribute to the observed J-shaped associations between sodium intake and clinical outcomes. By integrating the modulatory role of the dietary sodium-to-potassium ratio and the genetic/epigenetic determinants of individual salt-sensitive phenotypes, we propose a paradigmatic shift toward a precision nutrition approach.

View on PubMed →DOI: 10.3390/nu18121945